title: Laparoscopic versus robot-assisted bilateral nerve-sparing radical prostatectomy: comparison of pentafecta rates for a single surgeon.
abstract: BACKGROUND
  This study aimed to compare the pentafecta rates between laparoscopic radical prostatectomy (LRP) and robot-assisted radical prostatectomy (RALP) and to identify prognostic factors predicting the pentafecta for each technique.
  
  
  METHODS
  This prospective comparative study enrolled 248 consecutive male patients 70 years of age or younger with clinically localized prostate cancer [PCa: age ≤ 70 years, prostate-specific antigen (PSA) ≤ 10 ng/ml, biopsy Gleason score ≤ 7] who were fully continent, potent, and candidates for bilateral nerve-sparing (BNS) LRP or RALP. The pentafecta rates between LRP and RALP were compared. A logistic regression model was created to evaluate independent factors for achieving pentafecta.
  
  
  RESULTS
  In the final analysis, 91 LRP and 136 RALP patients were evaluated. The median follow-up period was 21 months for the 91 LRP patients and 18 months for the 136 RALP patients (p = 0.07). Of the 227 patients, 87 reached pentafecta [25 LRP patients (27.5 %) vs 62 RALP patients (45.6 %), p = 0.006]. Of the 140 patients who failed pentafecta, 90 (64.3 %) missed a single parameter. In these cases, erectile deficit was the leading cause of pentafecta failure, with a significant [corrected] difference between groups (80 % LRP cases that missed potency recovery [corrected] vs 53.3 % RALP, p = 0.007). Lower age, lower pathologic stage, and RALP are significantly associated with pentafecta as independent factors. For the pT3 disease, the two techniques did not differ significantly.
  
  
  CONCLUSIONS
  Patients submitted to BNS RP have low possibilities of achieving pentafecta. Use of the robotic platform by a single surgeon significantly enhances the possibility of achieving pentafecta independently of age and pathologic stage. Potency was the most difficult outcome to reach after surgery, and it was the main factor leading to pentafecta failure. LRP and RALP provide equivalent pentafecta rates for the pT3 disease and similar "tetrafecta" outcomes when potency recovery is not included among the postoperative expectations of the patient.
authors.affiliation: UOC of Urology, Department of Surgery, University of Tor Vergata, Policlinico Casilino, Rome, Italy, tasospao2003@yahoo.com.
authors.forename: Anastasios D
authors.initials: AD
authors.lastname: Asimakopoulos
authors.forename: Roberto
authors.initials: R
authors.lastname: Miano
authors.forename: Nicola
authors.initials: N
authors.lastname: Di Lorenzo
authors.forename: Enrico
authors.initials: E
authors.lastname: Spera
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Vespasiani
authors.forename: Camille
authors.initials: C
authors.lastname: Mugnier
mesh_terms: D000368:Aged; D005500:Follow-Up Studies; D013502:General Surgery / Q000706:statistics & numerical data*; D006801:Humans; D010535:Laparoscopy / Q000706:statistics & numerical data*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D060787:Neoplasm Grading; D009367:Neoplasm Staging; D059351:Organ Sparing Treatments / Q000706:statistics & numerical data*; D010525:Peripheral Nerves; D011379:Prognosis; D011446:Prospective Studies; D011468:Prostatectomy / Q000706:statistics & numerical data*; D011471:Prostatic Neoplasms / Q000473:pathology / Q000601:surgery*; D020127:Recovery of Function; D012371:Robotics / Q000706:statistics & numerical data*; D016896:Treatment Outcome